Paediatric Early Warning Score to Detect Deterioration in Paediatric Patients at a Tertiary Care Hospital of a Developing Country: A Validation Study.

Wasif Ilyas Vohra, Ayaz Ur Rehman, Anosha Aslam, Salman Khan, Qalab Abbas
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Abstract

Objective: To test the validity of the paediatric early warning score (PEWS) and to identify the patients with deteriorating clinical conditions who were reviewed by a rapid response team (RRT) and were advised higher level of care.

Study design: Observational study. Place and Duration of the Study: Paediatric ward and high dependency unit (HDU) of The Aga Khan University Hospital (AKUH), Karachi, Pakistan, from January 2021 to March 2022.

Methodology: All children aged 1 month to 18 years, admitted with non-surgical diagnoses at AKUH and referred for an RRT consultation were identified by non-probability consecutive sampling. The bedside nurse assessed the PEWS and alerted the clinical team. The patient's further course of action was decided based on the PEWS, detailed systemic examination, and laboratory workup. This aided in deciding the level of care (General ward, HDU, Paediatric Intensive Care Unit) required by the patients. Patients with length of stay >24 hours were included and those with did not resuscitate orders were excluded.

Results: Overall 10,032 patients were admitted to the ward and high dependency unit (HDU). Out of which, 323 (3.2%) patients had an RRT call and were included in the study. The median age of the study population was 3.15 years during the study period, and 30.3% were <1 year. System-wise admission diagnoses included respiratory (33.2%) and neurological diseases (16.1%). Median [interquartile range (IQR)] PEWS at RRT call was 2 (IQR, 1-2) on median admission day 2 (IQR, 1-3). The cumulative data at PEWS ≥3 demonstrated an area under the curve of 63% with a sensitivity of 90% and a specificity of 30%.

Conclusion: PEWS >3 can probably identify the patients at risk of deterioration with excellent sensitivity.

Key words: Paediatrics, Rapid response team, Early warning score.

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用于检测发展中国家三级医院儿科病人病情恶化的儿科预警评分:验证研究。
研究目的检验儿科早期预警评分(PEWS)的有效性,并确定哪些临床状况恶化的患者接受了快速反应小组(RRT)的审查并被建议接受更高级别的护理:研究设计:观察性研究。研究地点和时间:2021年1月至2022年3月,巴基斯坦卡拉奇阿迦汗大学医院(AKUH)儿科病房和重症监护病房(HDU):通过非概率连续抽样,确定所有在 AKUH 以非手术诊断入院并转诊 RRT 咨询的 1 个月至 18 岁儿童。床边护士对 PEWS 进行评估,并向临床团队发出警报。根据 PEWS、详细的全身检查和实验室检查结果,决定患者的进一步治疗方案。这有助于决定患者所需的护理级别(普通病房、加护病房、儿科重症监护病房)。住院时间超过 24 小时的患者包括在内,但不包括下达了不予抢救指令的患者:病房和重症监护室(HDU)共收治了 10,032 名患者。其中,323 名患者(3.2%)曾呼叫过 RRT 并被纳入研究。研究期间,研究对象的年龄中位数为 3.15 岁,30.3% 为结扎:PEWS>3可能能以极高的灵敏度识别有病情恶化风险的患者:儿科 快速反应小组 早期预警评分
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